Systems thinking, change and 'system change brokers'

In 2006, the UK government produced a report, called "Reaching out: an action plan on social inclusion", which argued that a large part of the problem of so-called 'hard to reach' people with 'complex needs' was as much to do with the inflexibility of services, which allow many people to simply slip out of reach. Overly rigid procedures, eligibility criteria or commissioning focussed too narrowly on particular needs, can mean that those with more complex needs are then more at risk of falling through the safety nets, drifting or crashing into exclusion.

(It has beenargued by Johnson that the demand for 'evidence based' treatments, especially in the health services, has unwittingly tended to exacerbate this tendency, in giving precedence to mainstream-able and standardisable treatments. The convincingly large datasets required for such evidence tend to exclude the more marginalised and cannot recognise the very person-centred interventions often needed for these groups.)

Yet there is in principle an ambition to create a comprehensive 'system'. A major national charitable funder, The Big Lottery, which has an increasingly useful role in finding experimental approaches, announced a multi-million pound programme, the Fulfilling Lives' 'Complex needs' programme, to promote and fund innovative attempts at 'system change'. One such approach now being trialled is the creation of local 'system brokers'.

System brokers work both within a service, and in the gaps between services. They oversee the work of a small team of staff who are each tasked with navigating a caseload of clients with multiple complex needs through the services in the system. But the brokers' key role, in addition, is brokering change within that system itself, where necessary. They have an explicit mandate to inform the system's commissioners on where there are systemic gaps that will need systemic change. In the Library we now have a video of an interview with Alex Smith and Ray Middleton, system change brokers in the Newcastle and Gateshead project, where they outline the approach.

Another of the Fulfilling Lives pilots involves testing out the Housing First approach in the UK context; and Housing First, which calls for a radical simplification of the multiple pathways from the street to independent housing, is thus in itself an "off the peg" systemic change approach. Another approach is radical budgetary devolution, in the form of Housing and/or Recovery Vouchers, that the individual can spend as they chose.

See also the two recent Lankelly Chase reports on the need for, and the pre-conditions for, whole system thinking, and system change.